17096_INGRAM, M D_19970520

CAMA AND DREDGE AND FILL < / ✓(�.
GENERAL 01706
PERMIT X
as authorized by the State of North Carolina
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15A NCAC 7 k` / ?r,,
Applicant Name 7 rl I-^ Phone Number
Address 7 f 5 ' i
City 5U_ d -r- State Zip
Project Location (County, State Road, Water Body, etc.) =' -4 <<' r
S/h SC16 h,
Type of Project Activity IR6 j r'rr,� /0
PROJECT DESCRIPTION
SKETCH A�`�/)
(SCALE:
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Pier (dock) length
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Groin length
number
Bulkhead length
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max. distance offshore
Basin, channel dimensions
cubic yards
Boat ramp dimensions
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Other
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This permit is subject to compliance with this application, site
drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine,
imprisonment or civil action; and may cause the permit to be-
come null and void.
This permit must be on the project site and accessible to the
permit officer when the project is inspected for compliance.
The applicant certifies by signing this permit that 1) this pro-
ject is consistent with the local land use plan and all local
ordinances, and 2) a written statement has been obtained from
adjacent riparian landowners certifying that they have no
objections to the proposed work.
applicant's signature
jj permit officer's signature
d .75 ? R-d 0--9 2
issuing date expiration date
attachments &Z'- 14 E ? P / 7 r U
In issuing this permit the State of North Carolina certifies that
this project is consistent with the North Carolina Coastal
Management Program.
application fe'e�

66-30/531
M. D. INGRAM SSN 237-54-1332 342 1325
RUTH E. INGRAM NCDL 5016758
275 STAR HILL DR. PH 919-393-7871 � Q cT
SWANSBORO, NC 28584 / 1oC 1
PAY TO THE — ff
ORDER OF
� DOLLARS
oFY CITIZENS 342
D A C. Citi = Balk 8 Trust Campaiy
j�ru �a� Cho Ctimn N.C. Trust
FOR-- - --- -- -- -- -- -- -- — ---- ---
1:053 1003001:34 L76 2 L9691110 L3 25
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'11 1' • ' ' ' ' �!' • JI' �1 1 �!
I hereby certify that I own property adjacent to A, A
7S
(Name of Propefty Owner)
property located at
(Lot, Block, Road, etc.)
on C f 7`1 -P-o r ��C , in C'�c,-�'� Cv , N. C.
(Waterbody) (Town and/or County)
He has described to me as shown below, the development he is proposing at that location,
and, I have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
zefilted iC byindividual prop
9=g development)
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Signa e
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Print or Type Name
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Telephone Number
Date: S - /� 7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
�57rQ c., is property located at
(Name of Property owner)
jj�/ (Lot, Block, Road, etc.)
�i�-� �e�C i C��, , , N.C.
vn in �� r— � �-� i
(Waterbody) (Town and/or County)
tie has described to me, as shown below, the development he is
proposing at that location, and, I have no objections to his
proposal.
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DESCRIPTION AND/OR DRAWING Of PROPOSED DEVELOPMENT:
(To filled in by individual proposing development)
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P i or Type Name
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